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Race/ethnicity affects the probability of finding an HLA-A, -B, -C and -DRB1 allele-matched unrelated donor and likelihood of subsequent transplant utilization

2012; Springer Nature; Volume: 48; Issue: 3 Linguagem: Inglês

10.1038/bmt.2012.150

1476-5365

Joseph Pidala, J. Kim, Michael J. Schell, S. J. Lee, Ryan Hillgruber, V. Nye, Ernesto Ayala, Melissa Alsina, Brian C. Betts, Ryan Bookout, Hugo F. Fernández, Teresa Field, Frederick L. Locke, Taiga Nishihori, J. L. Ochoa, Lia Perez, Janelle Perkins, J. Shapiro, Cheryl Tate, Marcie Tomblyn, Claudio Anasetti,

Renal Transplantation Outcomes and Treatments

Factors relevant to finding a suitable unrelated donor and barriers to effective transplant utilization are incompletely understood. Among a consecutive series of unrelated searches (n=531), an 8/8 HLA-A, -B, -C and -DRB1-matched unrelated donor was available for 289 (54%) patients, 7/8 for 159 (30%) and no donor for 83 (16%). Patients of Caucasian race (P<0.0001) were more likely to find a donor. Younger age (P=0.01), Caucasian race (P=0.03), lower CIBMTR (Center for International Blood and Marrow Transplantation Research) risk (P=0.005), and 8/8 HLA matching (P=0.005) were associated with higher odds of reaching hematopoietic cell transplantation (HCT). In a univariate analysis of OS, finding a donor was associated with hazard ratio (HR) of 0.85 (95% CI 0.63-1.2), P=0.31. Karnofsky performance status (KPS) accounted for interaction between having a donor and survival. Patients with KPS 90-100 and a donor had significantly reduced hazard for death (HR 0.59, 95% CI 0.38-0.90, P=0.02). These data provide estimates of the probability to find an unrelated donor in the era of high-resolution HLA typing, and identify potentially modifiable barriers to reaching HCT. Further efforts are needed to enhance effective donor identification and transplant utilization, particularly in non-Caucasian ethnic groups.